Association between cumulative rATG induction doses and kidney graft outcomes and adverse effects in kidney transplant patients: a systematic review and meta-analysis

ABSTRACT

Background

This systematic review and meta-analysis were performed to explore the association between rabbit thymoglobulin (rATG) doses and transplant-related efficacy and safety outcomes.

Methods

We searched PubMed and Scopus databases from inception up to June 2020. The primary efficacy and safety endpoints in kidney transplant recipients were evaluated.

Results

Data of 23 cohort studies (3457 patients) and three RCTs (154 patients) were extracted and analyzed. rATG doses of ≤4.5 m/kg was associated with lower rates of biopsy proven acute rejection, cytomegalovirus infection, BK virus infection, and malignancy with a comparable rate of delayed graft function, patients’ mortality, and death-censored graft loss compared to rATG total doses of 4.5–6 mg/kg or more than 6 mg/kg. The rATG doses of 3–4.5 mg/kg was associated with better outcomes in dose–response analysis.

Expert opinion

Cumulative rATG induction doses as much as 3–4.5 mg/kg is as effective as higher doses regarding to allograft and patient outcomes while minimizing potential adverse effects in kidney transplant recipients.

KEYWORDS:

• Acute rejection
• delayed graft function
• induction
• kidney transplantation
• rATG
• thymoglobulin

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contributions

Authors state that all of them have contributed significantly towards the conception, materialization and production of the current study. All authors approved the final version of the manuscript for publication and take full responsibility about all the work done in the study.

Supplementary material

Supplemental data for this article can be accessed here.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.